Management of coronary obstruction following transcatheter aortic valve replacement

Abstract

Although occlusion of the coronary arteries during transcatheter aortic valve replacement is rare, the mortality is high. In this review, we discuss the prevention and management of this complication. Occlusion of coronary ostia is a very rare, but serious, complication of transcatheter aortic valve replacement (TAVR). Although reported as only occurring in <1% of TAVR cases, it carries a high risk of fatality, with some series reporting a mortality rate as high as 40%. We present the management of an occluded left coronary artery after a self-expanding TAVR, and review the incidence, prevention, and management of this complication.

Hospital readmission rates are similar between patients with mechanical versus bioprosthetic aortic valves

“…The use of bAVR has continued to increase with the thought that when SVD occurs in bAVR, they can be treated with a TAVR V‐I‐V approach. Unfortunately, despite good immediate procedural outcomes, V‐I‐V continues to have increased prosthetic valve mean gradients and greater risk for coronary obstruction . Surgical bAVR are no different with suprannular placement and generate higher mean gradients than mAVR, resulting in greater risk for patient prosthesis mismatch.…”

Is there still a role for mechanical aortic valve prostheses in the TAVR era?

“…While VIV techniques have been shown to be technically successful and can be performed with minimal morbidity and mortality, they may result in significantly higher transvalvular gradients, especially in bAVRs of 21‐mm or less. VIV procedures have also been associated with an increased incidence of coronary artery ostial occlusion, which may also occur following bAVR . In the study by Kilic et al, the most common indication for readmission in bAVRs was congestive heart failure.…”

Right ventricular dysfunction 10 years following a Bentall procedure

“…Coronary artery obstruction during aortic valve procedures can occur acutely during transcatheter aortic valve replacement or open surgical aortic valve replacement . It may also occur during coronary artery reimplantation in a Bentall procedure.…”